Weinert M, Mayer H, Zojer E
Klinik für Anästhesiologie, Krankenhaus München Pasing, Helios Klinikum München West, Steinerweg 5, 81241, München, Deutschland,
Anaesthesist. 2015 Feb;64(2):137-44. doi: 10.1007/s00101-014-2323-x.
Specific communication training is currently not integrated into anesthesiology curricula. At the same time communication is an important key factor when working with colleagues, in the physician-patient relationship, during management of emergencies and in avoiding or reducing the legal consequences of adverse medical events. Therefore, focused attention should be brought to this area. In other high risk industries, specific communication training has been standard for a long time and in medicine there is an approach to teach and train these soft skills by simulation. Systematic communication training, however, is rarely an established component of specialist training. It is impossible not to communicate whereby nonverbal indications, such as gestures, mimic expression, posture and tone play an important part. Miscommunication, however, is common and leads to unproductive behavior. The cause of this is not always obvious. This article provides an overview of the communication models of Shannon, Watzlawick et al. and Schulz von Thun et al. and describes their limitations. The "Process Communication Model®" (PCM) is also introduced. An overview is provided with examples of how this tool can be used to look at the communication process from a systematic point of view. People have different psychological needs. Not taking care of these needs will result in individual stress behavior, which can be graded into first, second and third degrees of severity (driver behavior, mask behavior and desperation). These behavior patterns become exposed in predictable sequences. Furthermore, on the basis of this model, successful communication can be established while unproductive behavior that occurs during stress can be dealt with appropriately. Because of the importance of communication in all areas of medical care, opportunities exist to focus research on the influence of targeted communication on patient outcome, complications and management of emergencies.
目前，专业的沟通培训尚未纳入麻醉学课程体系。与此同时，沟通是与同事协作、医患关系处理、紧急情况管理以及避免或减少不良医疗事件法律后果的重要关键因素。因此，应重点关注这一领域。在其他高风险行业，专业的沟通培训早已成为标准，而在医学领域，有一种通过模拟来教授和培训这些软技能的方法。然而，系统的沟通培训很少成为专科培训的既定组成部分。不沟通是不可能的，其中非语言暗示，如手势、表情、姿势和语气起着重要作用。然而，沟通不畅很常见，并会导致无效行为。其原因并不总是显而易见的。本文概述了香农、瓦茨拉维克等人以及舒尔茨·冯·图恩等人的沟通模型，并描述了它们的局限性。还介绍了“过程沟通模型®”（PCM）。文中通过示例概述了如何使用该工具从系统的角度审视沟通过程。人们有不同的心理需求。忽视这些需求会导致个体应激行为，可分为轻度、中度和重度三个等级（驱动行为、伪装行为和绝望行为）。这些行为模式会按可预测的顺序显现出来。此外，基于该模型，可以建立成功的沟通，同时可以妥善处理应激期间出现的无效行为。鉴于沟通在医疗护理各个领域的重要性，有机会将研究重点放在针对性沟通对患者预后、并发症及紧急情况管理的影响上。
